<?php echo $header; ?><?php echo $column_left; ?>
<!-- Right Column -->				
		<div class="d4-col-right right">
			<?php echo $menu_content;?>
			<div class="padder"></div>

		<div class="category-head">
			<h2>Thay đổi thông tin cá nhân</h2>
		</div>
		<div class="hp-report">
										
				<div class="padder">
					
					<form id="form-validate" method="post" action="<?php $action?>">
						<input type="hidden" value="nuGYrfLl2y9mtFRh" name="form_key">
						<fieldset class="group-select wide" >
					<div class="head-alt2">
						<h4 class="title">Thông Tin Cá Nhân</h4>
					</div>
					<table style="border:1px solid #d9dde3; " cellspacing="0" class="data-table box-table shopping-cart" id="shopping-cart-table">
					
							<tbody>
								<tr class="first last odd">
									<td width="150px" style="text-align:right;">
										<span>Họ Tên <span class="required">*</span></span>
									</td>
									<td>
										<span><input type="text" size="80px;" class="required-entry input-text" name="name" value="<?php echo $name; ?>" ></span>
										<?php if ($error_name) { ?>
              								<br /><span class="error"><?php echo $error_name; ?></span>
              							<?php } ?>
									</td>
											
								</tr>
								<tr class="first last odd">
									<td style="text-align:right;">
										<span>Giới Tính <span class="required">*</span></span>
									</td>
									<td>
										<span><input type="radio" value="1" name="sex" <?php if(isset($sex) && ($sex == 1 || $sex == -1)){echo "checked";}?>>&nbsp;Nam &nbsp;
										<input type="radio" value="0" name="sex" <?php if(isset($sex) && ($sex == 0)){echo "checked";}?>>&nbsp;Nữ </span>
									</td>
											
								</tr>
								<tr class="first last odd">
									<td style="text-align:right;">
										<span>Ngày sinh nhật <span class="required">*</span></span>
									</td>
									<td>
										<span>
										<select style="float:left" name="birthday">
											<option value="0">- Ngày- </option>
											<?php for($i = 1; $i < 32 ;$i++){?>
												<?php if(isset($birthday) && $birthday == $i ){?>
													<option value="<?php echo $i;?>" SELECTED ><?php echo $i;?></option>
												<?php }else{?>
													<option value="<?php echo $i;?>"><?php echo $i;?></option>
												<?php }?>
											<?php }?>
										</select> 
										<select style="float:left" name="birthmonth">										
											<option value="0">- Tháng - </option>
											<?php for($i = 1; $i < 13 ;$i++){?>
												<?php if(isset($birthmonth) && $birthmonth == $i ){?>
													<option value="<?php echo $i;?>" SELECTED ><?php echo $i;?></option>
												<?php }else{?>
													<option value="<?php echo $i;?>"><?php echo $i;?></option>
												<?php }?>
											<?php }?>
										</select> 
										<select style="float:left" name="birthyear">
											<option value="0">- Năm - </option>
											<?php $year = date("Y");?>
											<?php for($i = $year - 100; $i < $year ;$i++){?>
												<?php if(isset($birthyear) && $birthyear == $i ){?>
													<option value="<?php echo $i;?>" SELECTED ><?php echo $i;?></option>
												<?php }else{?>
													<option value="<?php echo $i;?>"><?php echo $i;?></option>
												<?php }?>
											<?php }?>											
										</select>
										</span>
										<?php if ($error_birth) { ?>
              								<span class="error">&nbsp;&nbsp;<?php echo $error_birth; ?></span>
              							<?php } ?>										
									</td>
											
								</tr>
								<tr class="first last odd">
									<td style="text-align:right;">
										<span>Email<span class="required">*</span></span>
									</td>
									<td>
										<span><input type="text" size="80px;" class="required-entry input-text" value="<?php echo $email; ?>" name="email"></span>
										<?php if ($error_email) { ?>
											<br />
              								<span class="error"><?php echo $error_email; ?></span>
              							<?php } ?>									
									</td>
											
								</tr>
								<tr class="first last odd">
									<td style="text-align:right;">
										<span>Số điện thoại <span class="required"></span></span>
									</td>
									<td>
										<span><input type="text" size="80px;" class="required-entry input-text" name="telephone" value="<?php echo $telephone; ?>" onkeypress="return numbersonly(this, event);" maxlength="12"></span>
									</td>
											
								</tr>
								<tr class="first last odd">
									<td style="text-align:right;">
										<span>Số di động  <span class="required"></span></span>
									</td>
									<td>
										<span><input type="text" size="80px;" class="required-entry input-text" name="mobile" value="<?php echo $mobile; ?>" onkeypress="return numbersonly(this, event);" maxlength="12"></span>
									</td>
											
								</tr>
						</tbody>
					</table>
					
				</fieldset>
							
						<fieldset class="group-select wide" >
					<div class="head-alt2">
						<h4 class="title">Địa Chỉ Liên Lạc</h4>
					</div>
					<table style="border:1px solid #d9dde3; " cellspacing="0" class="data-table box-table shopping-cart" id="shopping-cart-table">
					
							<tbody>
								<tr class="first last odd">
									<td style="text-align:right;" width="150px">
										<span>Địa chỉ <span class="required"></span></span>
									</td>
									<td>
										<textarea style="width:430px;" name="address"><?php echo $address; ?></textarea>
									</td>
											
								</tr>
								
						</tbody>
					</table>
					
				</fieldset>
						<div class="button-set">
							<p class="required">* Bắt buộc</p>
							<a class="f-left" href="<?php echo $back;?>">« Trở lại</a>
							<input type="image" alt="Save Address" src="catalog/view/theme/default/images/btn_submit_1.gif">
						</div>
					</form>
					
					</div>
		</div>
    </div>
</div>
<script type="text/javascript">
<!--
function numbersonly(myfield, e)
{
var key;
var keychar;
if (window.event)
key = window.event.keyCode;
else if (e)
key = e.which;
else
return true;
keychar = String.fromCharCode(key);
// control keys
if ((key==null) || (key==0) || (key==8) ||
(key==9) || (key==27) || (key==13) )
return true;
// numbers
else if ((("0123456789").indexOf(keychar) > -1))
return true;
// decimal point jump
else
return false;
}
//-->
</script>    			
<?php echo $footer; ?> 